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ObjectiveTo test the efficacy of theTransform-Us!school- and home-based intervention on children’s physical activity (PA), sedentary behaviour (SB) and cardiometabolic risk factor profiles.MethodsA 30-month 2×2 factorial design cluster randomised controlled trial delivered in 20 primary schools (148 Year 3 classes) in Melbourne, Australia (2010–2012), that used pedagogical and environmental strategies to reduce and break up SB, promote PA or a combined approach, compared with usual practice. Primary outcomes (accelerometry data; n=348) were assessed at baseline, 18 and 30 months. Secondary outcomes included body mass index (BMI) and waist circumference (WC) (n=564), blood pressure (BP) (n=537) and biomarkers (minimum n=206). Generalised linear mixed models estimated the interactive effects of the PA and SB interventions on the outcomes. If there was no interaction, the main effects were assessed.ResultsAt 18 months, there were intervention effects on children’s weekday SB (−27 min, 95% CI: −47.3 to −5.3) for the PA intervention, and on children’s average day PA (5.5 min, 95% CI: 0.1 to 10.8) for the SB intervention. At 30 months, there was an intervention effect for children’s average day SB (−33.3 min, 95% CI: −50.6 and −16.0) for the SB intervention. Children’s BMI (PA and SB groups) and systolic BP (combined group) were lower, and diastolic BP (PA group) was higher. There were positive effects on WC at both time points (SB intervention) and mixed effects on blood parameters.ConclusionsTheTransform-Us!PA and SB interventions show promise as a pragmatic approach for reducing children’s SB and adiposity indicators; but achieving substantial increases in PA remains challenging.Trial registrationISRCTN83725066; ACTRN12609000715279.

Background TransformUs was a four-arm school-based intervention to increase physical activity and reduce sedentary behaviour among primary school children. Pedagogical and environmental strategies targeted the classroom, school grounds and family setting. The aims of this study were to evaluate program fidelity, dose, appropriateness, satisfaction and sustainability, and associations between implementation level and outcomes among the three intervention arms. Methods At baseline, 18-months (mid-intervention) and 30-months (post-intervention), teachers, parents and children completed surveys, and children wore GT3X ActiGraph accelerometers for 8 days at each time point to determine physical activity and sedentary time. Implementation data were pooled across the three intervention groups and teachers were categorised by level of implementation: (i) ‘Low’ (< 33% delivered); (ii) ‘Moderate’ (33–67% delivered); and (iii) ‘High’ (> 67% delivered). Linear and logistic mixed models examined between group differences in implementation, and the association with children’s physical activity and sedentary time outcomes. Qualitative survey data were analysed thematically. Results Among intervention recipients, 52% ( n = 85) of teachers, 29% ( n = 331) of parents and 92% ( n = 407) of children completed baseline evaluation surveys. At 18-months, teachers delivered on average 70% of the key messages, 65% set active/standing homework, 30% reported delivering > 1 standing lesson/day, and 56% delivered active breaks per day. The majority of teachers (96%) made activity/sports equipment available during recess and lunch, and also used this equipment in class (81%). Fidelity and dose of key messages and active homework reduced over time, whilst fidelity of standing lessons, active breaks and equipment use increased. TransformUs was deemed appropriate for the school setting and positively received. Implementation level and child behavioural outcomes were not associated. Integration of TransformUs into existing practices, children’s enjoyment, and teachers’ awareness of program benefits all facilitated delivery and sustainability. Conclusions This study demonstrated that intervention dose and fidelity increased over time, and that children’s enjoyment, senior school leadership and effective integration of interventions into school practices facilitated improved intervention delivery and sustainability. Teacher implementation level and child behavioural outcomes were unrelated, suggesting intervention efficacy was achieved irrespective of implementation variability. The potential translatability of TransformUs into practice contexts may therefore be increased. Findings have informed scale-up of TransformUs across Victoria, Australia...

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Natural play occurs when children explore and enjoy the natural environment through their freely chosen play (Natural England 2014. Natural England: Childhood and nature: A survey on changing relationships with nature across generations). This chapter will discuss natural play as an approach to outdoor learning and examine its role in children's cognitive, physical, social, and emotional development using examples from research. The chapter will acknowledge the current decline in natural play opportunities for children in the UK, compared with that of previous generations, and describe how promoting natural play through Forest Schools has been shown as a promising strategy to resolve this issue. Forest Schools offer "all ages regular opportunities to achieve and develop confidence through hands-on learning in a woodland environment" (Murray and O'Brien 2005. Such enthusiasm -a joy to see: An evaluation of Forest School in England, p. 11. http://www.forestresearch.gov. uk/website/forestresearch.nsf/ByUnique/INFD-6HKEMHS. Accessed 27 July 2014). The ethos, implementation, and outcomes of Forest Schools in the UK are outlined with supporting evidence. Finally, future directions will be described for natural play within Forest Schools as an approach for facilitating children's engagement with the natural environment. Reflections on recent programs and recommendations for future delivery strategies and implications for research will be also discussed.

Background Hip-worn accelerometer cut-points have poor validity for assessing children’s sedentary time, which may partly explain the equivocal health associations shown in prior research. Improved processing/classification methods for these monitors would enrich the evidence base and inform the development of more effective public health guidelines. The present study aimed to develop and evaluate a novel computational method (CHAP-child) for classifying sedentary time from hip-worn accelerometer data. Methods Participants were 278, 8–11-year-olds recruited from nine primary schools in Melbourne, Australia with differing socioeconomic status. Participants concurrently wore a thigh-worn activPAL (ground truth) and hip-worn ActiGraph (test measure) during up to 4 seasonal assessment periods, each lasting up to 8 days. activPAL data were used to train and evaluate the CHAP-child deep learning model to classify each 10-s epoch of raw ActiGraph acceleration data as sitting or non-sitting, creating comparable information from the two monitors. CHAP-child was evaluated alongside the current practice 100 counts per minute (cpm) method for hip-worn ActiGraph monitors. Performance was tested for each 10-s epoch and for participant-season level sedentary time and bout variables (e.g., mean bout duration). Results Across participant-seasons, CHAP-child correctly classified each epoch as sitting or non-sitting relative to activPAL, with mean balanced accuracy of 87.6% (SD = 5.3%). Sit-to-stand transitions were correctly classified with mean sensitivity of 76.3% (SD = 8.3). For most participant-season level variables, CHAP-child estimates were within ± 11% (mean absolute percent error [MAPE]) of activPAL, and correlations between CHAP-child and activPAL were generally very large (> 0.80). For the current practice 100 cpm method, most MAPEs were greater than ± 30% and most correlations were small or moderate (≤ 0.60) relative to activPAL. Conclusions There was strong support for the concurrent validity of the CHAP-child classification method, which allows researchers to derive activPAL-equivalent measures of sedentary time, sit-to-stand transitions, and sedentary bout patterns from hip-worn triaxial ActiGraph data. Applying CHAP-child to existing datasets may provide greater insights into the potential impacts and influences of sedentary time in children.

Background: Hip-worn accelerometers are commonly used, but data processed using the 100 counts per minute cut point do not accurately measure sitting patterns. We developed and validated a model to accurately classify sitting and sitting patterns using hip-worn accelerometer data from a wide age range of older adults. Methods: Deep learning models were trained with 30-Hz triaxial hip-worn accelerometer data as inputs and activPAL sitting/nonsitting events as ground truth. Data from 981 adults aged 35–99 years from cohorts in two continents were used to train the model, which we call CHAP-Adult (Convolutional Neural Network Hip Accelerometer Posture-Adult). Validation was conducted among 419 randomly selected adults not included in model training. Results: Mean errors (activPAL − CHAP-Adult) and 95% limits of agreement were: sedentary time −10.5 (−63.0, 42.0) min/day, breaks in sedentary time 1.9 (−9.2, 12.9) breaks/day, mean bout duration −0.6 (−4.0, 2.7) min, usual bout duration −1.4 (−8.3, 5.4) min, alpha .00 (−.04, .04), and time in ≥30-min bouts −15.1 (−84.3, 54.1) min/day. Respective mean (and absolute) percent errors were: −2.0% (4.0%), −4.7% (12.2%), 4.1% (11.6%), −4.4% (9.6%), 0.0% (1.4%), and 5.4% (9.6%). Pearson’s correlations were: .96, .92, .86, .92, .78, and .96. Error was generally consistent across age, gender, and body mass index groups with the largest deviations observed for those with body mass index ≥30 kg/m2. Conclusions: Overall, these strong validation results indicate CHAP-Adult represents a significant advancement in the ambulatory measurement of sitting and sitting patterns using hip-worn accelerometers. Pending external validation, it could be widely applied to data from around the world to extend understanding of the epidemiology and health consequences of sitting.

Natural play occurs when children explore and enjoy the natural environment through their freely chosen play (Natural England 2014. Natural England: Childhood and nature: A survey on changing relationships with nature across generations). This chapter will discuss natural play as an approach to outdoor learning and examine its role in children's cognitive, physical, social, and emotional development using examples from research. The chapter will acknowledge the current decline in natural play opportunities for children in the UK, compared with that of previous generations, and describe how promoting natural play through Forest Schools has been shown as a promising strategy to resolve this issue. Forest Schools offer "all ages regular opportunities to achieve and develop confidence through hands-on learning in a woodland environment" (Murray and O'Brien 2005. Such enthusiasm-a joy to see: An evaluation of Forest School in England, p. 11. http://www.forestresearch.gov. uk/website/forestresearch.nsf/ByUnique/INFD-6HKEMHS. Accessed 27 July 2014). The ethos, implementation, and outcomes of Forest Schools in the UK are outlined with supporting evidence. Finally, future directions will be described for natural play within Forest Schools as an approach for facilitating children's engagement with the natural environment. Reflections on recent programs and recommendations for future delivery strategies and implications for research will be also discussed.